Stimulant users are caught in fatal ‘fourth wave’ of opioid epidemic
- The Opioid epidemic is experiencing a fourth wave, marked by the mixing of stimulants like cocaine with fentanyl, a potent opioid 50 times stronger than heroin.
- In Rhode Island, about 75% of overdose deaths in 2022 were linked to fentanyl, highlighting the dangers of unsuspecting stimulant users.
- Research shows that illicit stimulants mixed with fentanyl are the most common drugs found in fentanyl-related overdoses nationwide.
- Black and African Americans are disproportionately affected by this crisis, with rising mortality rates among older Black and Hispanic individuals.
10 Articles
10 Articles

Stimulant Users Are Caught in Fatal ‘Fourth Wave’ of Opioid Epidemic
By Lynn Arditi, The Public’s Radio January 3, 2025 In Pawtucket, Rhode Island, near a storefront advertising “free” cellphones, J.R. sat in an empty back stairwell and showed a reporter how he tries to avoid overdosing when he smokes crack cocaine. KFF Health News is identifying him by his initials because he fears being arrested for using illegal drugs. It had been several hours since his last hit, and the chatty, middle-aged man’s hands move…


Stimulant users are caught in fatal 'fourth wave' of opioid epidemic
The mix of stimulants like cocaine and methamphetamines with fentanyl is driving the opioid epidemic's 'fourth wave.' This mixture presents powerful challenges to efforts to reduce overdoses because many users of stimulants don't know they are at risk of ingesting opioids, so they don't take overdose precautions.
'People are going to die today': Inside the fourth wave of America's deadliest epidemic
In Pawtucket, Rhode Island, near a storefront advertising “free” cellphones, J.R. sat in an empty back stairwell and showed a reporter how he tries to avoid overdosing when he smokes crack cocaine. KFF Health News is identifying him by his initials because he fears being arrested for using illegal drugs. It had been several hours since his last hit, and the chatty, middle-aged man’s hands moved quickly. In one hand, he held a glass pipe. In the …
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